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the HAES® files: The High Costs of Weight Loss Surgery

by Health At Every Size® Blog

by Shelley Bond

Editors’ Note: Last month, an article in JAMA Surgery reported that bariatric surgery was not associated with health care cost savings as previously believed by many insurance companies and health care analysts. The authors examined the health records of 29,820 BlueCross BlueShield plan members who had bariatric surgery with a 1:1 matched comparison group of persons not undergoing surgery. The study used health records dated January 1, 2002, through December 31, 2008. Overall, the authors concluded that “Bariatric surgery does not reduce overall health care costs in the long term.” The study focused exclusively on financial costs, though the authors do suggest that “future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.” We agree that the focus should be on health and well-being, and asked ASDAH Board member Shelley Bond, who has been outspoken about her opinion of bariatric surgery, if she would be willing to share her thoughts on the “costs” of weight loss surgery.

At the time I chose weight loss surgery (WLS), I was new to the HAES® concepts. I didn’t understand how they could—and eventually would – be an extremely positive part of my life and would lead to the self-acceptance that I’d never had. I was feeling desperate about being fat and was just coming off of a summer where I had been in many new situations and where I keenly felt my weight was a very negative factor. I felt desperate and hopeless. Let me be very clear: WLS is not a choice I would make today. It never made me thin and has left me with physical vulnerabilities and requirements that negatively remind me of that choice every day.

The following is not a study of any kind—just an observation from planet Shelley.

I had a Roux-en-Y technique weight loss surgery about 10 years ago. Of the eight or so people I personally know who have had WLS, I am the only one who has not had to have hospitalization or surgery to correct a subsequent problem related to the operation. Those are costs I’ve not had to pay, but many or even most people do incur them.

At the time, I had no trouble receiving the blessings of the insurance company for me to go ahead with the surgery. Since I doubt that the insurance company was concerning itself with my (perceived) happiness, I’m guessing I received their go-ahead based on the belief that I would be a less costly customer for them in the future if I was thinner, no matter their bariatric surgery costs. I’m bewildered by this, as WLS has been around now for many years. Haven’t the insurance companies been keeping tabs on what sort of costs their insureds have accumulated post-surgery either relating directly to the WLS or to the post- WLS body?

What sort of costs am I talking about just for me, who hasn’t had to have any subsequent surgeries or hospitalizations? Prior to surgery—and since my mid-20s—I’ve been treated for hypertension. Post-surgery, my blood pressure never really went down, and over the years my BP meds have changed and increased, all of which involved many doctor visits and medications.

I didn’t have diabetes at the time of surgery, but I developed it about a year ago, which surprised me: I didn’t know it was possible to get diabetes sometime after having WLS. This disease involves specialist visits every quarter, along with many fine drugs and monitors and testing strips. And diabetes comes with its own set of possible side effects which can be costly and life-changing, resulting in surgeries, hospitalizations and expensive medical equipment. Diabetes appears to be a pricey disease for the insured and the insurer.

At the time of my surgery, I was just entering the stage in life where people may develop joint inflammation/soreness due to arthritis. A post-WLS body cannot take anti-inflammatory meds. So for pain (in my case due mostly to a back injury from an accident in the 1980s, as well as occasional joint pain) I take prescription medications prescribed by a physiatrist.

And then there are the vitamins… It is recommended that you take a multivitamin, plus extra supplements of calcium, iron, vitamin B12, vitamin D, and vitamin K. Because the area of the intestine that absorbs the best has been bypassed, I need to take at least twice the recommended dosage of these vitamins and minerals or I will become malnourished. These supplements are very expensive. The supplements are so important that I have blood tests several times a year to make sure I am taking enough. Despite the supplements, I’ve had a difficult time maintaining acceptable levels of both vitamin D and iron.

Here are a few more costs that I don’t know quite how to compute into dollars. Again as a result of my inability to fully absorb food now, I must eat at least 70 grams of protein per day. That can be expensive. Since the surgery, I have a hair-trigger digestive system. My slight lactose intolerance pre-surgery has become a raging lactose intolerance. (Do you know that most drugs contain lactose? Every time I get a new prescription I need to be sure it either doesn’t have lactose or has amounts so small that it won’t upset my digestive system. This lactose sensitivity makes me miserable, and that’s a high price to pay!) I can’t eat most legumes. When I am not careful enough about my food intake, I pay for it in a most inconvenient way and too often end up canceling plans and staying at home as a result.

A few parting thoughts… I lost 100 pounds as a result of the surgery. I’ve regained about half of that. I’m very sorry that I had gastric bypass surgery and whenever possible I recommend not to do it when I’m asked my advice on the subject. The cost is very, very high.

Shelley Bond has been an active member of ASDAH for the past 5 years and currently serves as an “at large” member of the Board, as well as participating in the Membership and Internal Policy committees. She has also served on the planning committee for the 2011 and 2013 ASDAH Educational Conferences. Her personal business is BEADJOUX…slightly eccentric handmade jewelry. Shelley sells at many ASDAH and NAAFA functions, and features jewelry for women of size and substance.

13 Responses to “the HAES® files: The High Costs of Weight Loss Surgery”

Excellent post and one which like any on this topic merits a much bigger audience. Of course the other major and surprisingly common side effect of WLS is death, as my poor wife found out three weeks ago (eight years after a full roux-en-Y and three years after the last of several revisions). She suffered from most of the problems listed above, including difficulties managing her blood sugar, chronic malnutrition and dehydration, arthritis, depression, dumping, even cavities in every tooth in her head, before her pouch finally ruptured and killed her. (Her full story is recounted on the fathealth blog). Now I have to face life without my soulmate and best friend and our 20-month old son will have to grow up without his mama. I hate this surgery with a passion (she did too, by the end, especially as she also gained back over 100lb of the 200lb she lost) and have been trying to impress upon people why it’s a thoroughly bad idea and in most cases I’ve come across doesn’t do what it says on the tin. Although it’s too late for most of her family (a dynasty of bigger people) I’ve even convinced a few to reconsider, though most just don’t want to hear it – they think they would be happy to swap all the myriad downsides for the possibility of being thin.

Richie79, I’m terribly sorry for your loss. The heartbreak of losing your beloved partner is made even more devastating by the sad, sad cause. We will both continue trying to stop people from choosing WLS, but the strength of the societal messages we are up against makes it so hard to get through to people. Best, Shelley

My sister had the same surgery maybe 5 or 6 years ago. She did all the prescribed prep, including quitting smoking.
Now, these years later, she does have several of the malnutrition diseases, she’s picked smoking back up, and frankly she looks pretty terrible physically. I’m pretty sure she’s gained weight back – not all of it.
I’m so sorry that she did it, and I think she regrets it too, but the pressure is just so strong to “do something”…it makes me sad to think about her future.
I’m so sorry you went through this and continue to have issues…and they are still pushing for surgery at lower and lower weights!
I watched a Dr. Oz show (don’t judge me, I was weak ;-) ) about it and he thinks we should push it on everyone because it “cures” diabetes. UG!!!!

Dotto on all that you said. I knew of HAES at the time of my surgery in 2004 but none of my healthcare providers believed in it and told me that WLS was my “last chance”. I have all the same issues that you mentioned and have to restrict my activities to take in consideration where there is a bathroom. I’m not exactly despondent over my decision to have the surgery, but there most definitely is a price to pay and in the long term as I age I worry if the price will become higher.

Been there done that and I’m still paying for it (oh, not the surgery itself, I was on SSI at the time and Medicaid paid for that. go figure). I had a VBG 15 years ago, and I’m fatter now than I was before surgery. I’m also dealing with complications caused by the surgery, but finding a doctor willing to treat them as complications of the surgery is next to impossible (they all think those problems are cause by being fat). Right, I didn’t have them before the surgery, but I have them now. Hindsight is 20/20 and if I had it to do over again, I would tell my NP (who recommended this butchery) to take a very long walk off a short pier while wearing cement boots (the kicker is that she was also fat, but I didn’t see her signing up for digestive mutilation).

Thanks to Shelley for sharing her personal story and helping others to understand the range of costs associated with WLS. My heart goes out to you Shelley for all that you have and continue to endure thanks to rampant fat phobia in our society.

Shelley – Thank you SO MUCH for talking about such a personal subject. If I had not found HAES, I would definitely have considered one of these surgeries! These days I see a number of people who are having different mental health and physical issues after WLS and they have all assumed they were the “only one” having problems. We need more WLS survivors to speak up about their struggles – you are not alone!

If people considering these surgeries were really *completely informed* of all the risks these surgeries bring, and of all the work they will have to do ongoing to keep their perpetually malnourished bodies healthy, many fewer people would make the choice to go ahead with the surgeries.

Thank you for sharing this post. It reconfirms my belief about weight loss surgery. I had a doctor insist I go for a consult at the end of last year. I had considered this option and decided it was not for me. I got a different doctor. I will not trade my health in order to be thin.

Thank you, Shelley! In being the loving partner of a very large woman a few years ago, I went with her to three different surgical groups for conversations or seminars (sales pitches?) on their procedures–despite my grave reservations about WLS. (I had friends who died from complications of WLS, either at the time, or several years later.) Despite this, I felt that she had to make up her own mind, and I kept my mouth shut most of the time, except sometimes to suggest questions for her to ask the surgeons.

All surgeons gave a poor accounting of themselves; one stated that the procedure he had been performing for ten years was not good surgery “but it’s the best that we have.” I guess he deserves some kind of credit for honesty.

My partner, to her credit, decided against the surgery–without any pressure from me. PS–She died, not from being fat, but from COPD, a lung ailment caused by being a chain smoker for 22 years (before I knew her). WLS would not have helped her COPD, nor did any surgeon show much interest in her lung problems, except to assume that they would be better after the surgery.